Pediatric Rheumatology Online Journal → June 2003 → Systemic Onset Arthritis → Abstract #11

DETERMINANTS OF JOINT DAMAGE IN SYSTEMIC ONSET JRA (SOJRA)

C. Sandborg,¹ T. C. Lee,¹ K. Biederman,¹ P. Chira,¹ V. Saper,¹ H. Emery,² J. Kennedy,¹ S. Zehra,¹ D. McCurdy,³ T. Holmes,⁴ D. Bloch,⁴ E. Mellins.¹

¹Pediatric Rheumatology, Stanford University, Stanford, CA; ²Pediatric Rheumatology, UCSF, San Francisco, CA; ³Pediatric Rheumatology, Childrens Hospital of Orange County, Orange, CA; ⁴Health Research Policy Division of Epidemiology, Stanford University, Stanford, CA

To determine if clinical features present in the first 6 mo after onset of SOJRA correlate with severity of joint damage at 2 and 4 y after diagnosis, medical records from 58 children with SOJRA were reviewed. METHODS: Severity of systemic illness in the first 6 mo was graded: severe, if symptomatic cardiac disease, pulmonary disease, or macrophage activation syndrome were present; moderate, if WBC20,000, Plat500,000, or ESR70; and mild, if WBC20,000, Plat500,000, and ESR 20-70. Arthritis activity was scored: severe, if the active joint count (number of swollen or limited and painful joints) was 20; moderate, if 10-20, and mild, if 10. Severity of joint damage was defined as presence of greater than 50% limitation of 1 or more joints (not due to pain or swelling), or presence of erosions or fusion on xray after 2 y of F/U. RESULTS: 32 males and 26 females were evaluated. Severe joint damage was found in 15/58 patients at 2 y and 12/35 at 4 y. All patients had developed severe joint damage by the 2 y F/U. Moderate-severe systemic symptoms in the first 6 mo were not predictive of severe joint damage at 2 and 4 y F/U (p= .736). In contrast, moderate-severe arthritis activity in the first 6 mo was significantly associated with severe joint damage at 2 and 4 y F/U (p=.009). Severe joint damage at 2 and 4 y correlated with methotrexate usage in the first 6 mo (p=.023). Steroids was not associated with severe joint damage. CONCLUSIONS: Severity of systemic disease in the first 6 mo of disease does not correlate with severe joint damage at 2 y, suggesting different pathogenic mechanisms for systemic vs long-term articular outcomes. In contrast, moderate to severe activity of arthritis in 10 joints in the first 6 mo is correlated with joint damage. Furthermore, progression to severe joint damage in some patients occurred even with early treatment with methotrexate.